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Stress Nursing Job

Job Related Stress in Faculty of Nursing in Armed Forces Post Graduate Medical Institute

Introduction

Stress in not a new phenomena, it is recognized centuries back, but time, situation and causes are different. It has been identified in multiple professions on diverse nature of people at different ages and different stages. Relatively, it has been documented in books, journals, papers in which causes of stress and effects are different, but the management is not much different.

However, in dictionary “Stress is the psychological and physical state that results when perceived demands exceed an individual's ability to cope with them”. In addition, according to Brewer McMahan-Landers added that” number of conceptions of stress has emerged since the 1970s”. Further, According to Weiten (1999) stress define as “any circumstances that threatens or are perceived to threaten our well-being and thereby tax our adaptive capacities” (p.79).

According the literature job related stress in something new on which researchers and physicians are working because it is not yet identified. It varies from the nature of job, duration, environment and person’s life style. The focus of researchers is all kind of jobs, circumstances and accordingly management of the cause.

In addition, in human’s context and psychology stress is frequently used to describe the body response against the demands whether those demands are positive or negative (Ahmadi and Alireza, 2006). However, in every profession stress has threats to physical, psychological, and social effects, which reduce the workers efficiency, consequently affects the health of worker and ultimately organization.

My focus of writing this position paper is job stress in army nursing faculty in AFPGMI. Army institutes are less focused for research, but according to the literature stress is higher in army set up than other institutes. Adding in this point Ahmadi and Alireza, (2006) stated in their paper that “The military personnel are suffering from occupational stress. A majority at (60%) reported suffering from significant work stress. Almost half (42.5%) reported that work stress was a significant contributor to the onset of their mental illness” (p. 121).

However, since the education in nursing has accelerated form diploma to degree, faculties of nursing is facing more stress in academia. Job in military has its own terms and conditions which are important to obey without arguing. Perhaps that is the reason to suffer in stress. Therefore, in paper after giving introduction I will be writing background of job related stress in army. Relatively, description of issue, literature review, integration of theory to my topic and following that analysis of issue in literature review, further I will be giving recommendations, final position and at the end I will conclude my paper.

Background

The 21^st century is challenging for nursing education. These challenges have put enormous responsibilities on nursing faculty. These changes included paradigm shift of diploma to degree nursing education. However, the reason of this change is to produce competent knowledge able and skillful nurses, and on the other hand it is causing stress in faculty.

This is why their job becomes more demanding and time consuming, which is leading to the stress. The term “stress” is utilizing here as concept of strain and pressure (Ahmady, Changiz2, Masiello and Brommels, 2007). They are doing multiple roles at a time which is confusing for them as well.

Faculties of nursing are pillars for nursing education but, due to multiple pressures they are less autonomous in army, lack of recourses, faculty shortage, day to day postings and weak leadership are the sum of highlighters of making them stressful.

Army is a government institution chartered in 1965 to create education and health care programs and raise the status of nursing in Pakistan. Currently, nursing education in Army consists of a 3 year diploma program, Diploma in Intensive Care Unit (ICU), Diploma in Pediatrics, Diploma in Operation Theater (OT) Diploma in oncology, Diploma in anesthesiology, Diploma in Burn Centre, and a new entry level 4 year generic BScN program, and 2 year Post RN degree program. Further, there are five other schools in military other than AFPGMI which are CMH Multan, CMH Lahore, CMH Kharian, CMH Quetta and PNS Shifa a (Navol School). These programs are at small training level because they are running Diploma nursing and Midwifery and all are under nursing college AFPGMI Rawalpindi.

The generic entry level BScN program at Armed Forces Post Graduate Medical Institute (AFPGMI) was implemented in October 2005. This entry level for nursing is the most recent development in the evolution of nursing in Pakistan. This programme is very demanding for assessment, planning, and evaluation point of view.

Whereas, army is experiencing faculty shortage in nursing schools especially for baccalaureate and Post RNs programs. The main current problem is shortage of faculty in nursing, and it is estimated that this issue will be continuing (Huber, 2006). It is an era when nursing education needs qualified prepared faculty for nursing education to fulfill the demands of health and related issues. However, if faculty will face stress of any kind, she may not be able to perform effectively.

Description of Issue

I was faculty of nursing before joining at Aga Khan University Hospital (AKUH). Throughout my experience into nursing services, I have worked as a nurse, midwife, and team leader and as instructor for five years and this is about 16-17 year service in army. During my journey I have faced lot of stress in my army, but this was accelerated when I joined as faculty in AFPGMI.

This condition exaggerated when programmes were increasing but faculty was the same in number. Higher commands just pass orders without having idea that how much work faculty is already handling. These conditions delay the work and produce more stress. Furthermore, frequent orders make faculties overburden. In such condition, we cannot work as expected and feel our self helpless.

Since 2005, AFPGMI has started degree courses; the specialized faculties for that course are very few. Therefore, workload has increases, and there is much high demand of performance relatively, our leadership and management style is different than other institutes.

Our nursing leaders are not independent they have to follow the command orders which sometimes give feeling that may be we are ignored or our work is not appreciated. It is true that people are different in work capacities, but those who are really hard working feel more anxiety than others, because everyone may not having equal work. Those who are good worker are getting more work, and those who are doing less they receive less orders.

Further, after posting there is no mentoring or proper guidance for new arrivals so, the people can get proper orientation. Thus without mentoring or directions starting work in new institute is very frustrating, and I can well imagine when I joined AFPGMI soon after my teaching administration there was no one who could guide me that where I have to go, however, whatever I learned was at my own trail and errors. But at that time it was very frustrating and stressful.

Dealing with technology is most frustrating; there are very few computers against the whole faculty. The largest population of nurses does not comfortable and experienced in utilization of computer technology in their work consequently, they will be more experience in the computer with its knowledge and training ( Alquraini, 2006). There are few are having knowledge that how to operate them.

While everyone has to work on computer, one clerk to type every letter, every lecture and every question paper so turn comes after two day. Secondly, if faulty has to prepared lecture for multimedia, most of us do not know how to use it, if someone knows will not get it because, doctors and nurses are studying in the same institute however, they get those rooms which are with multimedia and our poor nursing students sit in rooms which do not have that facility.

In education it is difficult to learn everything at once, however once a person get trained just post out to other stations which are sometime training institute and sometimes none. Therefore, learning for every institute and adjustment is time consuming as well exasperating. Moreover, every work place has different cultures and every commandant and matron has different style of leadership, therefore they want work at their own style which is sometimes against the nature of person or capacity of the person which reduce interest in job and work.

All aspects of creating and inducing factors produce anger which converts in depression later, as well some time they burnout or sometimes cannot which results in anxiety and stress. Their attitude and behavior with students, colleagues, seniors, and family become aggressive which raises the conflicts.

However, for female’s job could be possible by family support, and by colleagues at working place. In this way their contacts with relatives and society become decreased. Moreover, many of us become physically unfit with psychological or physical illnesses. Heart irregularities, blood pressure, fatigue, lack of self esteem and poor performance are the common out comes.

Now for taking my position I am thinking and questioning myself that, how these stress producing factors could reduce and can produce satisfaction in all army faculties so they could work productive way, could improve their internal and external environment? How can I initiate to address the issue of job related stress in army? What strategies could be used to motivate the faculties? What measures we can take to improve our skills and knowledge to handle difficult tasks. How can we empower our leadership?

Literature Review

There is an extensive body of literature on the existence of stress in the nursing workforce and on the factors that influence it. All faculties have a role in reducing the job stress. Following, stress is a state where the individual’s resources are exceeds, and in result occupational stress increases which affects on professionals working and develop burnout syndrome, relatively burnout syndrome high level is 13%, which could affect physically and psychologically thus, patient could face difficulties in treatment at that level (Po¨hlmann, Jonas, Ruf, and Harzer, 2005).

Stress, burnout and job satisfaction become increasingly important in psychiatric environment over the last twenty years in particular growing concern about occupational stress and found nursing profession is leading in that (Pinikahana, and Happell, 2004). The process of burnout affects on interpersonal relationships and image of the person.

Stress in the work environment has been studied widely in some profession at special bases and found police work and teaching are particular more stressful which rapidly change mood on feels fatigued and depress, consequently, emotions are ways by which people could be value however, persons could be identified on their mood changes so, humor is best strategy to treat them (Healy, and McKay, 2000). Personals that exceed their work more than their capacity or recourses are more prone to job dissatisfaction and stress (Judkins, and Rind, 2005).

Conflicts between ones organizational role and other roles, feeling of stagnation and lack of growth in jobs, demand for production of excellent work in time restraints, conflict between one’s personnel values and job requirements, and role ambiguity are common examples of producing the job related stress in organization (Ahmady, Changiz, Masiello, and Brommels, 2007).

Gender difference in job related stress varies relatively, males reported less stress than females because they are extroverted burnout ratio is more than females so, lack of support at work area, job pressures are also prominent in anxiety producing factors (Berg, Hem, Lau, and Ekeberg, 2006). In our institution nursing leaders are having lack of involvement in policy making.

Thus, due to societal changes, traditional benefits such as financial security status and security are not guarantee for having no stress, and satisfaction because it all depends on organizational structure and healthy policies (Visser, Smets, Oort, and Haes, 2003). Moreover, it highlighted that 48 % of stress respondent could be classified as suffering from work related stress by the Reeder scale (Vanagas, and Bihari-Axelsson, 2005).

The life stresses enter in military personnel’s work place which signifies mixture of professional life with family life, including relations with spouse and children so, interaction, communication, financial management, family, friends, marital conflicts are high in them therefore, they are having high stress and low job satisfaction, which reveals as indicator of occupational weariness and burnout thus, increases mental tiredness and decreases capabilities of professional demands (Ahmadi, and Alireza, 2006). In addition, job demand is positively related to perceived stress (Rusli, Edimansyah, and Naing, 2008).

In the context of management standards successful intervention and reduction of job related stress could occur by reducing work load , job control, variety of autonomy, support, conflicts and role ambiguity relationships, out come change and organizational interventions on sickness absence (Reed, and Giacobbi, 2004). Moreover, early conceptualization of work stress emphasized that there is a discrepancy between skills and abilities, job demands, and between employee goals and values. However, ‘Management Standards’ approach to work-related stress works, such as working with supervisor is difficult, co-workers, subordinates and increasingly, customers (Mackay, Cousins, Kelly, Lee, and McCaig, 2004).

In one study it is revealed surprisingly that early atherosclerotic changes negatively correlated with the level of global job strain and some of it components for plaque formation (Bugajska, Widerszal-Bazyl, Radkiewicz, Pasierski, Szulczyk, Zabek, Wojciechowska, and Jddryka-Góral, 2008).

Integration Maslow’s Hierarchy Theory

By looking at problem I will be taking stand for issue in perspective of Maslow’s Hierarchy theory. We all are motivated by needs, and since the humans are born they are revolving around to fulfill their basic needs, thus Abraham Maslow's Hierarchy of Needs helps us in explaining that we all motivated by our needs.

In addition, these needs are categories in five portions and are according to the priority; physiological needs, safety needs, belonging needs, esteem needs and self-actualization. Human being is characterized by efforts to fulfill these needs. According to Maslow certain needs take precedence over others and once those have been satisfied, a person is able to redirect his/her efforts toward addressing the next pressing need.

Maslow’s Hierarchy of needs explains that everyone should satisfy with every need turn by turn, consequently, starts with lower level and reaches to the high level. As we have discussed that job priority is to fulfill the basic needs which physical and psychological needs are on priority because those are basic needs.

However, Maslow’s counted those needs as; air, food, drink, shelter, warmth, sex, sleep, etc. Adding in its second category is “safety needs” however that is important by providing shelter, security, order, law, and stability. Army provides house and security, but at the same time stability in job is important for the survival of employees.

Our belonging and love includes group work which assigned to lower the burden of work at one person, however less work automatically increase the love in colleagues, relatives and family. The most important point is provision of respect to every individual in the institute whether that is officer or at lower rank person. However, at some of the managerial responsibilities could be providing to the person to at his/ her own level so, she could feel honorable.

Maslow added one additional aspect of motivation, Cognitive and Aesthetic, which very crucial aspect to motivate and reimburse the employees by providing them extrinsic and intrinsic rewards. Army took lot of work from faculty but in reward, however it produces high level of de-motivation.

Analysis of the issue with reviewed literature

Being health care personals we can use strategies to reduce stress in job at our personnel level, leadership ship level and organization level. This would help to improve faculties’ health, attitudes, behaviors, quality education and their productivity. The major issue in job related stress is to delegate multiple tasks on faculties, because there is shortage of staff however it leads to further sub issues. However, improper job description, weak policies due to non involvement has separated faculty form the higher authorities. Therefore, doctor’s dominancy has increased.

Thus, senior nurses do not want to do work, they think that they have given enough time to work now its juniors turn to work. However, there is need to motivate them by meetings and counseling. This is why they are reluctant to join any course or study tour because they think now it is useless to indulge in any spatiality course.

This is reason those who are trained faculty working more than others. I read literature in which found this attitude in nurses is all over the world due to lack of incentives. Nurse educator’s shortage indicates shortage of qualified nurses (Kelly, 2002). They want to search opportunities which pay them more according to their skills, knowledge and experience. However, it is need to arrange short refresher courses for teaching learning skills, computer and specializations.

The purpose of providing all supports are to reduce the stress in faculty so, can work efficiently and effectively. However, by utilizing all facts and figures and its prevention will work to decrease job related stress.

Recommendation

To come up with positive outcomes there is need to restructure, and revise the total instructors inventory for AFPGMI, because since the college is came into inventory there 12 nursing instructors, two clinical instructors, one dept chief and one chief instructor. In that revision policy one strong nursing leader should be invited. Additionally, AFPGMI could higher nurses form other department till the revision of staff allotment list.

Huber (2006) suggested that “In an effort to deal with short staffing, nurse managers’ nurse mangers are often required to do the following: float nurses to areas in which they are not cross trained” (p. 749).This strategy would increase the number of staff by which work load would be decrease, however, people would work timely and consistently.

Computer training in four or six month to improve the staff’s skills and knowledge so, they could handle at their end. This strategy would enhance satisfaction in them and minimize adjustment problem. They will feel competent, independent and satisfied. Those nurses, who are having more computer experience, are more positive because it’s training influence at their attitudes more positively (Alquraini, 2006).

Interpersonal relationship development in faculty will talk each other and will give small remedies to deal with raising factors. Humor is one of the strategies which linked to reduce stress and was introduced by Kobasa in 1979, because it works as a mediator or buffer of stress (Judkins, and Rind, 2005). This strategy would encourage relieving the mental pressures and pre occupation in faculties.

Work appraisal has shown significant results in lowering the work related stress (Judkins, and Rind, 2005). As a human being this is need of every individual to be admired and appreciated. Once we are working in set up where everything is strictly checking out then why not appreciation to motivate people? (Himter, and Houghton, 1993) has found in regard to strategies to reduce stress at work place; support and appreciation for seniors has 61% importance, for a reduction in workload 59%.

Fourth strategy work climate could create drastic change in which support of colleagues and working environment has focused, furthermore, reorganization of extra efforts by allowing a conference visit and availability of resources could help as well (Visser, Smets, Oort, and Haes, 2003).

Fifth strategy is training handling stress, motivation and counseling session, educational and research activities favorite executive activities, sports, and entertainment can help to reduce job related stress (Ahmadi, and Alireza, 2006).

Final position

Faculty should be sent for refresher courses so, their knowledge and skills should be according to the demand of today’s education. That could be of weeks, months or year course. Pakistan Nursing Council should make training prgramme for those nurses who have not received any formal or informal refresher course in last five years.

During posting to the AFPGMI profile of the faculty should be check critically that what is qualification of the faculty and how many specialties she has, because according to PNC policies OT, ITC, Anesthesia and other specialty courses could be run by specialized nurses. Once they post in the faculty then it takes time to post out, however as there is permission of only twelve faculties so, new postings cannot occur.

Mentoring should be given for the new posted faculties or should buddy that faculty with experience faculty for three to six months so they could get some information about the procedures, process and policies.

There is need to push our nursing leaders so they should become assertive and should speak for them and for their subordinate. So, they could be involved in policy making and recruitments and retentions. Because faculties observe that their senior has less power than that produce great anxiety because they mirror their role in the same way.

For implantation of this recommendation that can sit with faculties, subordinates and can discuss that how they get in the policies and procedures and how they raise their voice for the future nurses. Those who are fresh graduates they are exposed to different institutes however they are more aware so, their involvement in that meetings could encourage more to the nursing leaders.

Our faculties do not sent for foreign countries however, for their training and exposure they could sent out for some change environment, which reduce anxiety levels by looking at other set ups.

Before task delegation to the faculty assessment of her previous work, resources availability, her personnel capabilities of doing the task and time constrains should keep in mind, because every individual is different from others however, should not over occupy the person.

We should demand to have our own budget because, faculties always run for the pen pencils, papers, stationary, books, registers, computers to other offices however, we should have our pool in nursing department so the process of approval, sanctions and others could save the time. Because this is very time consuming, it divert the faculty from her actual duty and tasks.

There should be a counselor at the pool of AFPGMI, so that when ever somebody face the physical, psychological and social constrains could approach it and could get treatment in time.

Autonomy, confidentiality and respect are basic component which should not break however, at personnel level if someone has problem with others should not burnout or become aggressive but should be passion and humble and should take individuals in confidence to solve the problem or to resolve the conflicts.

To have healthy relations with family and relatives, every individual should be relieve after three to six months so, faculties could spent time with their families and children, because saturated minds always create and think negatively. Counseling with family member or meetings with family could help.

Small trips, outings with colleagues could help to reimburse the interpersonal relationships at AFPGMI level. This way could help to work in productive way.

Other five stations should work at their own, because when faculties work for AFPGMI as well as for the other stations it becomes hectic, especially when they are working with diploma, midwifery and AFPGMI degree and sociality programs. Thus, their faculties could have better idea that what they have taught, and what should be in paper.

Clerical staff should increase at organization level so faculties could take assistance.

Conclusion

Faculties are important in nursing education, since the changes occurred in nursing education at national and international level the stress is became significant in all faculties. Burnout, conflicts among each other frustration and anxiety are the common symptoms, moreover physical, psychological and social problems are raised. Stress in education is current issue of interest in researchers; however, they are probing this issue at different angels.

According to their found factors this issue could be minimize or reduce according to the factors and situations in which interpersonal relationships, family involvement, motivation, extra incentives in way of extrinsic and intrinsic rewards, nursing leadership involvement with the faculty and at policy level could help it out.

Moreover, delegation of tasks according to faculty capacities, provision of resources and awareness to handle computer technology are remedies to deal with this issue. It could be resolved at three stages one personnel, nursing leadership and management level and organization level. AFPGMI is institute which is struggling to reach at global level nursing production thus, its aim is to produce competent and quality care provider nurses. However, by looking/resolving this issue it can expedite the process of reaching its goal.

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